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Rheumatology Advance Access originally published online on December 20, 2005
Rheumatology 2006 45(5):629-635; doi:10.1093/rheumatology/kei260
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Cost-effective detection of non-antidouble-stranded DNA antinuclear antibody specificities in daily clinical practice

P. A. J. M. Vos, E. J. E. G. Bast1 and R. H. W. M. Derksen

Department of Rheumatology and Clinical Immunology and 1 Laboratory of Immunology, University Medical Centre, Utrecht, The Netherlands.

Correspondence to: P. A. J. M. Vos, Department of Rheumatology and Clinical Immunology (F02.127), University Medical Centre, PO Box 85500, 3508GA Utrecht, The Netherlands. E-mail: p.a.j.m.vos{at}azu.nl

Objectives. To compare the utility of indirect immunofluorescence for the detection of antinuclear antibodies (ANA-IIF) and a fully automated test (ELiA SymphonyTM) that detects antibodies against a mixture of nuclear and cytoplasmic antigens (ENA), to select sera that should be tested for non-antidouble-stranded DNA (dsDNA) antinuclear antibodies in a relatively expensive automated line immunoassay (INNO-LIATMANA update, Lineblot).

Methods. All 328 sera sent to the laboratory for ANA or anti-ENA tests, over a 4 month period were evaluated in all three assays. Results were related to signs and symptoms of systemic autoimmune disease (AID) that patients had before or at the time of blood sampling.

Results. Overall, 72 (22%) sera were Lineblot positive. Of 198 patients without clinical manifestations of AID, 7% were Lineblot positive. Limiting Lineblot to sera positive in either ANA-IIF or Symphony tests failed to detect 26 (ANA-IIF) and 22 (Symphony) Lineblot-reactive sera, with 15 sera being negative in both assays. From a clinical point of view, failure to detect these reactivities was not important in most cases.

Conclusions. Restriction of performance of Lineblot to patients with at least one criterion for AID is an ideal and cost-effective strategy. In ignorance of clinical signs and symptoms, screening of sera by ANA-IIF or Symphony strongly reduces the costs of anti-ENA detection, with minimal loss in diagnostic capacity. Based on small differences, including the fact that anti-dsDNA antibodies give a positive ANA-IIF, we prefer screening with ANA-IIF over Symphony.

KEY WORDS: Antinuclear antibodies, ENA, Health economics


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